Project Summary/Abstract Recently increasing costs and declining health care, particularly in patients with chronic diseases, have led to major health care delivery and payment reform initiatives. One approach to reform includes the establishment of accountable care organizations (ACOs), groups of providers and health care organizations who deliver coordinated care to a defined patient population. Effective care coordination has the potential to achieve quality improvement and cost control by reducing preventable hospital admissions and readmissions, decreasing emergency department visits, and improving care transitions. However, no single measure or set of measures exists that is able to produce comprehensive, real-time, quantifiable measurements of care coordination. Our long-term goal is to improve care coordination through ACOs to improve outcomes and reduce costs in patients with chronic diseases. Our overall objectives in this R03 proposal are to implement EHR-based care coordination measures, develop a framework illustrating key domains for measuring care coordination in the ACO context, and map each of the EHR-based measures to the framework domains. We plan to accomplish our overall objective by pursuing the following two specific aims: 1) Implement EHR-based measures to assess care coordination in an ACO, and 2) Develop and map EHR-based measures to a framework of key domains for ACO care coordination. This proposal is significant, because it extends prior research to facilitate timelier, more comprehensive, and more accurate ACO evaluations, and, as a result can help identify areas of care coordination that can be improved in both electronic health records and ACOs to improve health care quality and reduce costs in patients.